Laparoscopy is a surgical procedure performed through small incisions in the abdomen using specialized instruments. A thin cylindrical instrument called a laparoscope, connected to a camera, is used to provide a clear picture of the abdominal cavity to the surgeon.
Prior to starting a surgical procedure a small incision is created, and then a trocar is inserted through the incision. Trocars typically range in diameter from 5 to 12 mm and provide a passageway for the introduction of medical devices into the abdomen. Typically, several incisions 5-12 mm in length are created. An insufflator is also used to inflate the cavity with carbon dioxide, thus creating space for the surgeon to perform the medical procedure and providing a viewing field. A special medical device called a laparoscope is inserted through the trocar so the surgeon can view the cavity content.
The origins of the word laparoscope can be traced back to the Greek word for “laparo” meaning “flank,” which is the area of the body located between the ribs and hips, commonly referred to as the abdomen, and the word “scope” which means to look at or examine. Hence laparoscopes provide means for viewing the interior of the abdomen of a patient.
The first use of a laparoscope goes as far back as 400 BC where the physician Hippocrates (460-377 BC) mentioned the use of a device called a rectoscope. Its use was for inspecting the oral cavity and pharynx of a person. When a tool is used to view the interior of a person through a natural opening in the body, such as through the mouth or nose, it is more accurately referred to as an endoscope. Laparoscopes and endoscopes have allowed for tremendous strides forward in the medical field.
It wasn't until 1805 that a physician named Phillip Bozzini of Mainz, Germany invented the lichtleiter, also referred to as the Bozzini Endoscope. The lichtleiter consisted of two parts: (1) a light container with an optical part and (2) a mechanical part which consisted of viewing tubes adapted to fit inside a body cavity. The lichtleiter was a tube incorporating various attachments which used concave lenses, with half of the tube transmitting light from a candle to the tip of the device and the other half returning the reflected light, providing the surgeon an interior view of a cavity. Thus, the candle, with angled mirrors inside the device, provides the light that enables the physician to see into the abdominal cavity. This approach was not practical because of its limitations of maintaining a heated light source, but it was the predecessor of today's laparoscopes and, at the time, was the first device to allow inspection of the interior of a body cavity.
In 1901, George Kelling performed a laparoscopy on a dog using a technique that introduced air into the abdominal cavity. In 1910 Victor Elner used a gastroscope to view the inside of a stomach and shortly thereafter a flexible gastroscope was designed. Thereafter, in 1911, the first laparoscopy was performed on a human by the Swedish doctor H. C. Jacobeus. In spite of the technical advances that were being made, problems persisted, such as the heat produced at the distal tip of the scope and visualization troubles, such as blind spots being present in the field of view, all limiting the use of laparoscopes. Its main purpose thus remained for diagnostic purposes.
In the early 20th century, with the invention of the light bulb and electrical devices by Thomas Edison, significant advances began taking place; finally small light sources could be attached to the distal tip of laparoscopes without the need for cooling. The next great evolution took place in the 1950's when significant advances in fiber optics provided greater flexibility and the introduction of small light sources at the distal tip of the laparoscope into the abdomen without burning the patient's tissues.
As the art of surgery kept evolving, limited interest was focused on minimally invasive type surgeries. However, as some of the many advantages became apparent, such as lower operating cost, less patient trauma, less scarring, less pain, fewer surgical complications, quicker recovery times, shortened hospital stays, and less chance of infection, a need developed to find therapeutic uses for laparoscopes. In the 1970's, thanks to gynecologists and gastroenterologists, the use of laparoscopy began changing from diagnostic to therapeutic.
The development of miniaturized high-resolution television cameras and CCDs (charged coupled devices) propelled advances in therapeutic use of laparoscopes. As problems presented themselves, inventors focused on solutions that kept laparoscopy moving forward. An example of how a problem in laparoscopy led to a solution is the problem of lens fogging during visualization which developed in surgery due to intermittent insertion and removal of a laparoscope from within a body cavity. Inventors, such as Ricardo Alexander Gomez and Sandy Lawrence Heck developed and patented a revolutionary method for maintaining laparoscopic lenses crystal clear during procedures and dramatically improved the visualization and effectiveness of these types of surgeries with the use of a device called a D-Help®. Today there is a need for smaller and more effective laparoscopic tools, means of providing direct visualization and methods that minimize the use of additional trocars inserted into a patient's abdominal cavity.
As the field of minimally invasive surgery continues evolving, less invasive techniques are desired and the need for smaller laparoscopic tools also developed. A newer version of laparoscopy has developed and is referred to as needlescopic surgery. Needlescopic surgery is an advance over laparoscopic surgery inasmuch as incisions smaller than 3 millimeters are now possible. Virtually no scarring occurs, pain is reduced, and recovery times are faster. The problem associated with this new procedure is the limited functionality of the insertion instrument. As these instruments became thinner, the heads of the instruments also became smaller and were too small to effectively manipulate tissues and organs. For this reason, among others, needlescopic surgery is not functional for most procedures and has not been adopted by the surgical community.
People have experimented with the concept of attaching larger instrument heads to thin shafts inside the body, but no effective method has been developed to facilitate the insertion and attachment of such instrument heads within the body.
It has been a long term goal of surgeons specializing in minimally invasive procedures to be able to perform surgery with much smaller incisions while still having means to view the area of interest within the cavity. Therefore, there is a need in the field of needlescopic surgery for means for effectively providing and attaching laparoscopic sized instrument heads to small diameter instrument shafts such as needlescopic shafts within the body cavity while using direct visualization such that the number and size of the incisions are minimized.
These objectives being met, as well as other aspects, features and advantages of the present invention will become more readily apparent from perusal of the figures and detailed description of exemplary preferred embodiments, which follow.